Healthcare Provider Details

I. General information

NPI: 1285256602
Provider Name (Legal Business Name): KOTLERMAN FAMILY HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2020
Last Update Date: 05/07/2020
Certification Date: 05/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 E FAIRHAVEN AVE STE 209
BURLINGTON WA
98233-1700
US

IV. Provider business mailing address

1100 GREENLEAF AVE
BURLINGTON WA
98233-2017
US

V. Phone/Fax

Practice location:
  • Phone: 360-661-9029
  • Fax:
Mailing address:
  • Phone: 310-663-5265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: ZACHARY KOTLERMAN
Title or Position: OWNER
Credential: DC
Phone: 310-663-5265